Outpatient Training

Rady Children's Outpatient clinic is the largest provider of mental health services for children and adolescents in San Diego County. 

Rady Children’s Outpatient Psychiatry
All First year fellows (4 hours per week required)
Traditional track Second year fellows (3 days per week)

The Outpatient Psychiatry Division is located one mile from the central campus of Rady Children's Hospital. The Division also operates satellite clinics in Oceanside and Escondido (20 miles from Rady Children’s Hospital), as well as a host of school-based programs throughout San Diego County. The clinic averages 60 new intakes per month with an ongoing caseload of 800 patients, accounting for approximately 1,400 visits per month.

All traditional track fellows have a required part‑time rotation in the Outpatient Psychiatry Division during the 2nd Year of training for three days per week. This rotation takes place at the main San Diego clinic and the satellite clinics in Oceanside and Escondido. A majority of patients are between 5 and 15 years of age but patients between 3 and 18 are served. Patients from all diagnostic categories are represented, including developmental, mood, anxiety, psychotic, eating, disruptive, and elimination disorders. Most referrals are for externalizing disorders (ADHD, Oppositional Disorders and Conduct Problems), many of who also have academic or learning problems. The population consists of a diverse ethnic mixture with 98% public funded and 2% private insurance and self-pay patients. All first year fellows have a four hour rotation in the central campus outpatient psychiatry clinic. Traditional track second year fellows spend time at the central campus outpatient psychiatry clinic and may rotate up to one day per week at the satellite clinics.

The San Diego Clinic is organized clinically and administratively into 3 multidisciplinary teams. Each team is comprised of senior staff and trainees from the disciplines of psychiatry, psychology, social work, and marriage and family therapy. Teams meet weekly for 1.5 hours. All new cases that have been evaluated in the preceding week are discussed. Diagnostic considerations and treatment issues are reviewed with the goal of developing a teamoriented intervention plan. Challenging clinical cases in ongoing treatment as well as administrative questions are also routinely discussed.

Treatment approaches are varied but include individual, family, group, pharmacotherapy, behavior therapy and parent training techniques. The case load for 1st Year residents is approximately 10–12 patients and for 2nd Year residents is 40–50 patients total, including 6–8 long-term psychotherapy cases, 1 diagnostic every other week, and medication evaluations. Residents have 3 hours of individual supervision weekly. The faculty includes 3 child psychiatrists, 3 psychologists, 5 psychiatric social workers, and 7 marriage and family therapists. The Outpatient Clinics are also a training site for the disciplines of psychology, social work, and marriage and family therapy. Trainees rotate on a yearly basis.

Family Health Centers of San Diego 

All first year fellows (traditional and community tracks):

Family Health Centers of San Diego (FHCSD) is a community clinic providing primary care, dental, pediatric services and mental health care to over 155,000 individuals per year in San Diego. FHCSD is accredited by the Joint Commission and certified by the National Committee for Quality Assurance as a Patient Centered Medical Home.  FHCSD delivers high quality care, which is accessible and affordable to members of the community.  FHCSD also plays a key role in increasing access to mental health treatment in the community, providing care to children and adolescents in the primary care setting, as well as to those transitioning out of higher levels of outpatient care.

All first year fellows (both traditional and community tracks) have a required 2.5 months rotation at FHCSD during which they spend 2.5 days per week at a mental health clinic, and one afternoon at an integrated site with Pediatrics, for a total of 6 half day sessions per week. At the main clinic, fellows will provide psychiatric assessment, evaluation for psychopharmacology, and ongoing psychopharmacologic management. At the integrated site, they engage in cutting edge evidence based collaborative care treatment of adolescents with mental health challenges in the primary care setting.  They see on average 3-4 patients per half-day and have direct, on-site supervision for every case they see from UCSD clinical faculty and from FHCSD child psychiatrists. Fellows do not have call obligations to Family Health Centers.

The educational experience at FHCSD offers not only a rich clinical rotation and exposure to the community clinic setting, but also an introduction to administrative and organizational issues relevant to public sector behavioral health services. The FHCSD clinic is located 15 minutes drive from Rady Children's Hospital.

Vista Hill Foundation

Community track second year fellow (12 hours per week):

Vista Hill Foundation (VHF) is a not-for-profit organization with more than sixty years of experience providing psychiatric services to youth and families in San Diego.  VHF operates the innovative SmartCare Integrated Behavioral Health Consultation Program, which leverages televideo and other technologies to deliver psychiatric expertise to primary care providers, and individuals and families struggling with mental illness from across the county. SmartCare serves more than 2,000 individuals annually.  VHF also offers school based mental health services through their Learning Assistance Center programs, which provides mental health services to students with special learning needs and behavioral concerns in multiple school districts across the county.  Additional VHF services include the Bridge Teen Recovery Center, an outpatient program for adolescents struggling with substance abuse, and the Juvenile Court Clinic, which provides intensive transitional psychiatric services for youth referred by the Juvenile Court.  The second year fellow on the community track has the opportunity to rotate through VHF programs, for 12 hours per week.  In these programs fellows provide psychiatric assessment, psychopharmacologic management, and multi-disciplinary team supervision, and have opportunity to provide psychiatric consultation to the Juvenile Court and to primary care settings.  Though there is some difference between programs, on average, fellows see 3 to 4 patients per half-day session. The community track second year fellow receives weekly supervision and mentoring by a board certified child and adolescent psychiatrist who is an experienced national leader in the field of community child/adolescent psychiatry who has direct oversight responsibility for the programs to which the fellow will be assigned. The fellow will also have a program staff psychiatrist providing mentoring and guidance for each clinical rotation. Fellows do not have call obligations to VHF programs. 

The educational experience at VHF offers broad and in-depth exposure to multiple populations and multiple modalities of service provision relevant to community child/adolescent psychiatry with the goal of optimally preparing the fellow for a career in the public sector.  In addition, this rotation trains fellows in cutting edge, evidence based integration services that are unique in San Diego County. Vista Hill Foundation is located five minutes drive from Rady Children's Hospital.

 

San Diego Center for Children

Community track second year fellow (12 hours per week):

San Diego Center for Children (SDCC) has provided services for children, adolescents and families in San Diego for nearly 130 years. SDCC is Joint Commission accredited for behavioral healthcare and offers a continuum of mental health programming which includes wrap services, school based services, residential treatment and outpatient psychiatry, reaching over 1000 children per day. The second year fellow on the community track has the opportunity to rotate in SDCC programs for 12 hours per week to provide psychiatric assessment, CBT therapy sessions, family psychoeducation, and psychopharmacologic management.  During this experience, fellows will work with adolescents and families in a range of settings, including in the outpatient clinic, on the WRAP team, and in the residential treatment center. Fellows will see 3 to 4 patients per half-day session. The community track second year fellow receives weekly supervision and mentoring by UCSD faculty as well program staff board certified child and adolescent psychiatrists who provide mentoring and guidance for each program site. Fellows do not have call obligations to SDCC programs.  

The educational experience at SDCC provides the fellow with a unique view into the continuum of care from residential to outpatient treatment. By working with patients in residential treatment, then participating in WRAP designed to help patients and families with the transition from residential back to the community, and lastly, providing care in clinics serving patients who have fully transition out of residential, fellows achieve a greater understanding of the clinical, social, and administrative challenges facing each level of care.  This rotation also plays a role in preparing the fellow for a career in the public sector.  San Diego Center for Children is located five minutes drive from Rady Children's Hospital.


KickStart  (Outpatient elective)
Supervisor: Craig Wronski, MD and Meg Lawrence, MD
2-month rotation: (4 hours per week) 
Kickstart is a diverse clinical team specially trained to educate the community, treat youth and assist families in preventing psychosis. The program is located 6 miles from Radys Children’s Hospital. They serve young people ages 12 to 25, their families, and their social networks to build support around the youth and promote success in relationships, education and employment. Kickstart is a Prevention and Early Intervention program funded through San Diego County Health and Human Services Agency and the Mental Health Services Act. Kickstart strives to keep hope alive through education and early intervention. 
The Kickstart team consists of mental health professionals trained to assess and treat youth experiencing early warning signs of psychosis.

Kickstart actively outreaches to the communities of San Diego to help reduce misunderstandings about serious mental illness and provide information about early identification and treatment. Community members who are most likely to help identify these youth include staff at secondary schools, colleges, nurses, physicians, military leaders, spiritual leaders, police, mental health professionals and community centers. 
KickStart’s caseload ranges from 90–150, with 10–20 new intakes per month. 60–70% of these patient’s see their in house psychiatrist. 50% of these patients have MediCal, 30% are uninsured and 20% have private insurances. Most patients enrolled at KickStart have either Psychosis NOS, Bipolar Disorder or Major Depressive Disorder. Treatment includes

KickStart’s multidisciplinary team meets three times per week to adequately go through the entire patient load. The Child Psychiatry Fellow will assume an active role in a multidisciplinary team meeting once per week. They are not expected to have a formal caseload but should be available for consultation from other members in the team. They are expected to actively work with case managers and therapists by accompanying them to the patient's homes, school or hospital wards if warranted. They are expected to learn from other disciplines in the program including therapists, rehabilitation technicians, care coordinators, and to assist with active community outreach by visiting schools, community centers or other public venues to provide psychoeducation and information about mental illness.

The Sam & Rose Stein Education Center  (Outpatient elective)
Supervision: Mark Chenven, MD and Charmi Patel, MD 2-month Rotation: (4 hours per week) The Sam & Rose Education Center is a Certified Nonpublic School. It is located 5 miles from Rady Children’s Hospital.

Stein Education Center currently enrolls 125 students per year. The program provides a caring environment, sensitive to student needs for students who are 5–22 years old. They provide highly individualized instruction for students with moderate to severe disabilities including autism, intellectual disabilities and emotional disturbances.

Individualized education and behavior programs are developed for each student to meet their specific needs.  An intensive student to staff ratio is used, involving special education teachers, speech therapists, occupational therapists, counselors, psychologists and other aide level staff.  Both academic and communitybased functional curriculum options are available. Vocational training and transition services are provided to secondary level students. Consultation with a Board Certified Child Psychiatrist is also part of the program. Approximately 50% of the students see their inhouse psychiatrist.  Their diagnoses include ADHD, ImpulseControl Disorders, Mood Disorders, as well as Autism and Mental Retardation.  90–95% of the students have MediCal and 5–10% have private insurances.  The Psychiatrist sees the students with their teaching staff and family member and/or other external caretaker (group home staff).  Education and program staff meet for IEP's and other treatment team meetings biannually.  The psychiatrist sees his or her patients biweekly to every 4 months. 

The child and adolescent psychiatry fellow rotating at Stein will assume an active role treating 2–3 patients from the psychiatrist’s caseload with direct supervision for the staff child and adolescent psychiatrist.  The fellow will provide medication management for these patients as well as psychoeducation to their families and special education teachers.  The child and adolescent psychiatry  fellow is also expected to attend at least 2 IEP meetings during their 2month rotation and offer psychiatric consultation to the IEP team.